scholarly journals Endovascular treatment of superior vena cava syndrome does not preclude continued use of indwelling hemodialysis and chemotherapy lines

2021 ◽  
Vol 5 ◽  
pp. 22
Author(s):  
Molly Casey ◽  
Sagar Desai ◽  
Vinit Khanna

Obstruction of the Super Vena Cava (SVC) can result in symptoms, such as facial plethora and swelling, and be due to a variety of underlying causes besides lung malignancies, the rates of which have changed over time; the underlying etiology is used to determine the best management strategy. This case report aims to discuss the role of etiology in determining the best initial treatment for SVC syndrome (SVCS) and outlines the unique management for a patient that represents the changing demographics of SVCS causes. A 73-year-old male with end-stage renal disease and metastatic carcinoma of the colon presented with swelling of the jaw, neck, and tongue. Computed tomography (CT) scan showed chronic thrombosis of the SVC and bilateral brachiocephalic veins. He had been receiving hemodialysis and chemotherapy through central venous catheters (CVCs) that traversed the SVC and terminated in the right atrium. Treatment involved double-barrel stent reconstruction of the SVC with a snare technique to temporarily reposition the chemotherapy port catheter and exchange of the hemodialysis catheter. After this single procedure, he experienced relief of symptoms without disrupting the use of his CVCs for further hemodialysis or chemotherapy appointments. For cases of SVCS due to underlying lung malignancies, which has been and remains the most common cause, endovascular stenting is reserved as a palliative measure when treatment of a refractory malignancy fails to resolve the obstruction and for when symptoms are severe because most cases are not life-threatening. However, increased use of CVCs has caused a rise in SVCS due to thrombosis, for which stenting is the first-line treatment. Of the few previously published case reports that depict using a snare technique to temporarily reposition a CVC, they all describe cases due to lung malignancies. Outlining this case presentation can increase awareness of thrombotic stenosis as an increasingly common cause of SVCS, which may occur in patients with a broader range of underlying conditions, ages, and life expectancies and require a wider array of physicians to be knowledgeable of management strategies. Furthermore, detailing this unique technique can provide therapeutic alternatives that show how endovascular interventions do not disrupt interdisciplinary treatment plans or preclude continued use of CVCs. While stenting technology has improved dramatically since its inception, follow-up on stent patency will help determine if expanding treatment for lower acuity cases is beneficial. Endovascular stenting is the treatment of choice for thrombotic causes of SVCS, which is becoming more common due to the increased use of CVCs. Techniques to temporarily reposition CVCs intra-procedurally allow for limited disruption in multidisciplinary treatment plans for patients with complex underlying conditions.

2021 ◽  
pp. 1-3
Author(s):  
Rajashekar Rangappa Mudaraddi ◽  
Hany Fawzi Greiss ◽  
Navin Kumar Manickam

Central venous cannulation is the most common procedure performed in perioperative setting and intensive care unit. Many case reports reported unusual positioning of central line catheters. Here, we would like to report a case of central line path in persistent left superior vena cava, a rare entity with a course similar to the right internal jugular central line. Preoperative computed tomography chest showed duplex superior vena cava which was not reported.


2020 ◽  
Vol 62 (2) ◽  
pp. 244-246
Author(s):  
Tomoya Harada ◽  
Mikihiro Inoue ◽  
Keiichi Uchida ◽  
Hiroyuki Ohashi ◽  
Masato Kusunoki

2010 ◽  
Vol 51 (3) ◽  
pp. 256-259 ◽  
Author(s):  
David Da Ines ◽  
Pascal Chabrot ◽  
Pascal Motreff ◽  
Agaïcha Alfidja ◽  
Lucie Cassagnes ◽  
...  

Percutaneous stenting of the superior vena cava (SVC) is usually recommended as a palliative procedure for malignant SVC obstruction with low reported morbidity. Complications are uncommon and usually of minor consequence. We report two unusual cases of cardiac tamponade following SVC stenting in patients with malignant SVC syndrome. Echocardiography allows rapid diagnosis and guides pericardial drainage in the interventional radiology suite.


2006 ◽  
Vol 113 (2) ◽  
pp. 242-246 ◽  
Author(s):  
Heather L. Ratliff ◽  
Mohammed Yousufuddin ◽  
Wesley R. Lieving ◽  
Brent E. Watson ◽  
Amer Malas ◽  
...  

2019 ◽  
Vol 25 (2) ◽  
pp. 174-183
Author(s):  
Himanshu Deshwal ◽  
Subha Ghosh ◽  
Karen Magruder ◽  
John R Bartholomew ◽  
Jennifer Montgomery ◽  
...  

Fibrosing mediastinitis (FM) is a rare disorder of inflammation and fibrosis involving the mediastinum. The formation of fibroinflammatory mass in the mediastinum can lead to obstruction of mediastinal structures and cause severe debilitating and life-threatening symptoms. Superior vena cava syndrome (SVCS) is a dreaded complication of FM with no medical therapy proven to be efficacious. Spiral vein grafting has long been utilized as first-line therapy for SVC syndrome due to FM. Endovascular repair with stents and angioplasty for malignant causes of SVC syndrome is well established. However, there are limited data on their utility in SVC syndrome due to FM. We present two cases of SVC syndrome due to FM treated with endovascular stenting and a detailed review of current literature on its utility in SVCS due to benign causes.


2013 ◽  
Vol 2013 (aug30 1) ◽  
pp. bcr2013010356-bcr2013010356
Author(s):  
F. Nasser ◽  
R. N. Cavalcante ◽  
F. L. Galastri ◽  
B. B. Affonso

2009 ◽  
Vol 8 (4) ◽  
pp. 281-287 ◽  
Author(s):  
Lianxiang Xiao ◽  
Zhenjia Li ◽  
Lebin Wu ◽  
Zengtao Sun ◽  
Xianghong Yu

Feasibility and efficacy of sequentially performed endovascular stenting and Iodine-125 brachytherapy for malignant superior vena cava syndrome (SVCS) were evaluated. Thirty-four patients with malignant SVCS caused by NSCLC underwent sequential treatment of endovascular stenting and Iodine-125 brachytherapy. SVCS was diagnosed in all patients by CT images or vena-cavography. Pathology diagnosis was acquired by image guided biopsy. Endovascular stent placement was performed as first-line treatment for symptom relief. CT-guided Iodine-125 seed implantation performed 24hr after stenting. Clinical end points were resolution of symptoms and local efficacy of primary malignancy regression. Symptom relief rate was >90% after 24hr and 97% after 3 months. No migration of seeds or restenosis occurred in any patient. The local efficacy (defined as either partial or complete response) was 53%, 79%, 88% and 74% after 1, 3, 6 and 12months, respectively. Mean SVCS-free survival time was 305 days (range 120–960 days). Two patients were still alive at the time of this writing, Thirty-one died from progression and one died from acute heart disease. Sequentially performed endovascular stenting and Iodine-125 brachytherapy provides a safe and effective alternative for malignant SVCS caused by NSCLC.


2014 ◽  
Vol 14 (1) ◽  
pp. 80-83
Author(s):  
Tommy Sheu ◽  
Joella Wilson ◽  
Larry Steven Carpenter

AbstractThe rarity of PEComa tumours has precluded any clinical trials, but surgery remains the most commonly reported treatment modality with just a few reports on treatment plans involving chemoradiation. We describe a patient with a mediastinal PEComa who presented with symptoms concerning for superior vena cava syndrome. She was deemed inoperable and was thus treated exclusively with chemoradiation therapy. The use of chemoradiation in the treatment of PEComa tumours is reviewed.


2008 ◽  
Vol 16 (2) ◽  
pp. 143-146 ◽  
Author(s):  
Vasiliki Kostopoulou ◽  
Marinos L. Tsiatas ◽  
Dimitrios A. Kelekis ◽  
Meletios-Athanasios Dimopoulos ◽  
Christos A. Papadimitriou

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